Written by Aubrey Phelps MS RDN LDN INFCP CLC
Since tube-fed babies receive a certain amount of food through the tube based on calculations, not their own efforts, pumping parents have very specific volume goals to meet in order to keep up with the needed amounts. This can be particularly tricky, as having a tube-fed baby is strongly akin to having twins: you offer the chance for your baby to eat orally, but then have to pump, essentially taking time to do double feedings EVERY time they need to eat. This is exhausting and time-consuming, especially for parents who are heading back to work. And the reality is that some people, no matter their efforts, are not going to be able to keep up with baby’s needs. So, our primary job in supporting these parents is to remind them that that’s ok: any amount of chestmilk is amazing and offers benefits can be helpful and encouraging.
Alongside that primary message of encouragement, here are a few other recommendations that you can suggest in order to address supply concerns:
1) Just like with actual nursing at the chest, milk production is based on demand/milk removal. As such, encourage the parent to pump as often as we would expect baby to be nursing. This is typically every 2 hours in the first months, and every 3 hours after about 4 months, with potentially one longer stretches overnight. In other words, parents should be pumping 8-12 times a day up until about 6 months of age (adjusted, for premature littles).
2) Milk production gets most fully established and is the most “malleable” in the first 6 or so weeks postpartum. That means that the foundation for a good, long pumping journey really needs to get established from the beginning. If a parent wants to try and increase their supply, increased milk removal is the best option. They can try adding in more frequent pumping session or adding a “power pump,” which involves having a parent pump for 20 minutes, break for 10, then pump for another 20, for up to three rounds.
3) Hand expressing after pumping, just for a few minutes, can be effective in increasing stimulation and therefore milk production. This can also be more effective in mobilizing fat into the milk.
4) Pumping both sides at the same time will encourage more milk output than doing one side at a time. It’s also more efficient!
5) A hands-free nursing bra or flange set (like Freemie) can be a game-changer. This allows a parent to check e-mails, hold a baby, eat, etc. while pumping, thus freeing up a little bit of their pumping time, which can make parents more likely to stick with it.
Ultimately, exclusively pumping is a true labor of love and takes time and consistency. Having parents work with a lactation counselor, even if they aren’t nursing at the chest, sooner rather than later can go a long way in their success.